Your injector's technique seems unorthodox.
Typically, brows are injected with about 5 or so injection points, not just 2. 15 units is a small dose for a male. We typically use 25 in a female, and 30-40 units in the average male with well developed frown muscles.
All the best,
The furrows between the brows form because of a complex of five muscles that work together to pull the brows together and down: the large procerus which lies in the center and pulls the central brow down; two corrugator muscles that angle from the mid to midlateral brow downward and toward the medial brow at the bridge of the nose,and two depressor supercilli muscles which are located at either side of the bridge of the nose and which pull the medial brow down. (The periorbital muscle, which is a large muscle that surrounds the eye and allows you to shut the eyes and squint, contributes only a bit to the downward movement of the brows medially, and more so laterally.) At least five, and sometimes nine, locations are injected to allow the muscles that knit the brows together and down to relax upward and outward. This number is necessary to keep the effect localized and prevent diffusion to muscles one does not want to relax, as well as to relax all portions of the relevant muscles.
Sometimes injections are so painless that a patient doesn't realize it is happening, or I have seen a patient, distracted by everything going on and our conversation, not be aware that an injection has taken place. And I always inject less the first time a patient is having the treatment -- to minimize the chances of any side effects and save the patient money, and to avoid an unnatural overrelaxation, it is better to add more a week or two later than to overdo it, and once a good pattern and dose is established for that patient, the injector will know what to do in a single session the next time around. But 15 units is very low for a male glabellar complex, even for the very first session, unless the muscles are very small, such as in an Asian face.
If you have more injected now, you should still have the benefit of the 15 units injected and might need 15 to 25 more to have a good effect.
I agree with you 100%. there is something fishy here. When we inject for frown lines, the most common number of injections is 5. If you look at published guidelines for dosing of these medications, in a male, 20 Units would be considered the lower end of normal. Obviously some people are different but typically that is standard. there are some people who only do 3-4 injections but 2 I've never seen or read about it. In fact, I am in the process of completing the largest study assessing all three types of these medications used in North America and I've reviewed over 150 articles and never seen experts inject only 2 injections in any reported study. Anyway, i digress.
If I were you, this is what I would want to know
1) the expiry date on the Botox - I've seen this happen before
2) how they dilute the product - there are people who over dilute to save money and you end up getting a lower dose than you pay for
3) Why they only do 2 injections
4) What muscles they inject into
5) Ask to SEE the "Botox" make sure you see where it was made as there are counterfeits.
Hopefully that helps you ask a few questions and make sure all is ok.
Botox and all the toxins and fillers should only be injected by skilled injectors well-trained in the injectables themselves. Most men -- and this is just a generalization -- need much more toxin than that for significant relaxing to occur. The adage is "Buyer beware," and if you went somewhere where the person did not know what he or she was doing, then there is probably not much you can do. Most doctors will see their patients again in two weeks because on occasion we need to inject more to optimize the result. So I would recommend you go back and get more; you already paid, and now they need to make sure it does something.
My typical dosage for "glabellar" lines in males is roughly 30units. 15 may have been too little for you to see an effect, especially if you have large muscles. 2 injection points seems a little unusual, but it all depends on an individuals anatomy and muscular contraction. I would go back to the doctor and explain your concerns. I wish you the best of luck, Dr. Emer.
That is an excellent question! 15 units in a male is quite a small number. But performing Botox well, really is an art. Every individual is different and the treatments have to be customized. In many cases individuals need more Botox.
Sometimes you think you're getting a deal, but it wasn't a deal if it didn't work. I would recommend you see a reputable dermatologist or plastic surgeon.
I wish you the best of luck.
Dr. Daniel Radin, Dermatologist, Windsor, Ontario, Canada
The most common reason that you don't see any results after 15 days is because you did not get enough Botox injected. Muscles of facial expression in men are larger and stronger than women, therefore more Botox is required to weaken the muscle. I usually use between 25-35 units in men in order to sufficiently weaken the muscle and treat the wrinkles. You might want to follow up with your injector to see if you need more Botox. Good luck to you!
Many times I don't show patients the needles themselves because patients don't like to see needles. Think about the dentist. They don't come at you with the needle, they come in from the side and you barely see it. So the position of your doctor isn't necessarily off. Injection sites matter a great deal, as do the concentration of the Botox and the number of units injected. For many men I find that 1.5 or even 2x as much Botox is needed because the muscles in many men are just stronger. So I would think that 15 units wasn't enough for any kind of significant change. I would suggest a follow-up with your injector.
"This answer has been solicited without seeing this patient and
cannot be held as true medical advice, but only opinion. Seek in-person
treatment with a trained medical professional for appropriate care."
Response to any neuromodulator whether BOTOX@, DYSPORT@, or XEOMIN@ may be affected by many variables like: authenticity of product, dilution, age (if expired), injection technique, and individual patient response. In my experience, 15 units to treat the glabella area or the "11s" is a starting number I often use for females. Typically women receiving this amount are either happy or prefer a little more neuromodulator for less movement. I personally, like a little movement, so tend to under treat, because it is easier to add a little more than try to take it away. I have found that males generally require more than 15 units, sometimes twice as much because male muscles tend to be larger. I have new patients follow-up in 2 weeks to assess response. I recommend that you request a follow-up with your injector. You will likely either need more BOTOX@ or need to try one of the other neuromodulators. I have found that there are some patients who will not respond to BOTOX@, but will respond to either DYSPORT@ or XEOMIN@ and vice-versa. Remember, it is best to choose either a board certified Dermatologist or Plastic Surgeon when considering injections to the face.
Hi Otto. If you can contract the muscles between the eyes fully 15 days after injection, something is wrong. While you probably need more product than was injected - we use 20-30 units for males between the eyes - 15 units should have had some benefit.
One other issue of note is that with very deep creases, especially in male patients, we sometimes need to follow on with Restylane or Juvederm after the Botox or Dysport has taken effect. If the crease is very deep, Botox or Dysport can put the muscles to sleep but still not completely address the issue of visible lines. Without a photo we would not know if this is the case in your situation.
Either way, you should follow up with your injector to find out why you are still contracting.